| Doctor Name: | MS. STACI ELIZABETH OLDHAM |
| NPI Number: | 1023236536 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | 527845 |
| Business Practice Address: | 801 Tenth Street Magdalena, NM - 87825 |
| Business Phone Number: | 5758543162 |
| Business Fax Number: | |
| Mailing Address: | 801 Tenth Street, MAGDALENA |
| State: | NM |
| Postal Code: | 87825 |
| Phone Number: | 5758543162 |
| Fax Number: | |
| NPI Enumeration Date: | 04/22/2007 |
| NPI Last Update Date: | 08/31/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 527845 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |